Young G A, Vincent P C
Clin Haematol. 1980 Oct;9(3):483-504.
Drug-induced agranulocytosis is relatively rare. It is a heterogeneous disorder in pathogenetic terms, not surprisingly in view of its idosyncratic nature. Indeed, one drug might cause agranulocytosis by different mechanisms in different patients. Recent investigations suggest that there are at least three mechanisms by which it can be produced, namely differences in drug pharmacokinetics, abnormal sensitivity of myeloid precursors, and adverse immune responses to drug administration. Genetic factors are important and could act via any of the above. Examples have been reported where one drug has been shown to cause damage at different levels of neutrophil development in one patient, and others where the drug acted at different sites in different patients. Any drug is potentially capable of toxicity and should be viewed with suspicion in the appropriate context. Drug-induced agranulocytosis is usually a self-limiting condition (provided toxic drugs are withdrawn) with complete resolution within two weeks. However, the mortality rate during the acute phase is high, and therefore prompt supportive therapy with isolation and broad-spectrum antibiotics for infection are mandatory during periods of severe neutropenia. The place of granulocyte transfusions in this disorder has not yet been established, and needs to be decided in each individual case.
药物性粒细胞缺乏症相对罕见。从发病机制来看，它是一种异质性疾病，鉴于其特异质性，这并不奇怪。实际上，一种药物在不同患者中可能通过不同机制导致粒细胞缺乏症。最近的研究表明，至少有三种机制可导致该病发生，即药物药代动力学差异、髓系前体细胞异常敏感以及对药物给药的不良免疫反应。遗传因素很重要，可能通过上述任何一种机制起作用。有报道称，一种药物在一名患者的不同中性粒细胞发育水平上造成损害，还有其他情况是该药物在不同患者的不同部位起作用。任何药物都有潜在的毒性，在适当情况下应予以怀疑。药物性粒细胞缺乏症通常是一种自限性疾病（前提是停用有毒药物），两周内可完全缓解。然而，急性期的死亡率很高，因此在严重中性粒细胞减少期间，必须立即进行支持性治疗，包括隔离和使用广谱抗生素治疗感染。粒细胞输注在这种疾病中的作用尚未确定，需要根据每个具体病例来决定。
